Association Between Mean Arterial Pressure and Survival in Patients Admitted to the Intensive Care Unit After Cardiac Arrest With Vasopressor Support: A Retrospective Study

BackgroundMortality among patients admitted to the intensive care unit (ICU) after cardiac arrest (CA) is high. Hemodynamic management in the phase of post-resuscitation is recommended by international guidelines, but the optimal mean arterial pressure (MAP) range is still unclear. The main objective of this study is to investigate the association between time spent in different MAP and ICU mortality in PCA patients admitted to ICU with vasopressor support. MethodsIt was a retrospective, observational study in cardiac arrest patients admitted to the ICU with vasopressor support during the first 24 hours. The main exposure was time spent in MAP. The primary outcome was ICU mortality. Associations between time spent in MAP and ICU mortality were evaluated using ten MAP thresholds: 100, 95, 90, 85, 80, 75, 70, 65, 60, and 55 mmHg. Multivariable logistic regression analyses were used to test the association between time spent in different MAP categories and ICU mortality. Results The study included 1018 eligible subjects in ICUs from 156 hospitals, of which 453 (44%) patients died during hospitalization and 208 (37%) patients discharged home. A significant association was found between time spent in MAP and the ICU mortality when MAP thresholds of ≤55mmHg (OR 1.25, 95% CI 1.09-1. 45, p = 0.002) and ≤60 mmHg (OR 1.13, 95% CI 1.02-1.24, p = 0.014) were used. Thresholds of MAP ≥ 65 mmHg were not associated with mortality. The percentage of time spent in MAP of ≤90mmHg (OR 1.09, 95% CI 1.01-1.18), ≤ 95mmHg (OR 1.12, 95% CI 1.01-1.24,) and ≤100mmHg (OR 1.19, 95% CI 1.04-1.38) were associated with a higher odds ratio for discharged home outcome, suggesting that MAP of ≥90mmHg, ≥95mmHg and ≥100mmHg were associated with lower probability of discharged home. ConclusionsThese results imply that for post-cardiac arrest patients with vasopressor support, time spent in MAP of ≤60mmHg or less was associated with higher ICU mortality and MAP of ≥90 mmHg or more was associated with a lower probability for discharged home.